| NPI | 1225044399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 18555) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD045033E) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2015-02-25 |